Provider Demographics
NPI:1972669950
Name:SHELTON, BASIL CRAIG (MFTI#55399)
Entity Type:Individual
Prefix:
First Name:BASIL
Middle Name:CRAIG
Last Name:SHELTON
Suffix:
Gender:M
Credentials:MFTI#55399
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 POLK ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-7813
Mailing Address - Country:US
Mailing Address - Phone:415-292-3400
Mailing Address - Fax:415-292-3404
Practice Address - Street 1:730 POLK ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-7813
Practice Address - Country:US
Practice Address - Phone:415-292-3400
Practice Address - Fax:415-292-3404
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist